Greig Douglas, Corbalán Ramón, Castro Pablo, Campos Pabla, Lamich Rubén, Yovaniniz Patricio
Departamento de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago, Chile.
Rev Med Chil. 2008 Sep;136(9):1098-106. Epub 2008 Nov 12.
Primary angioplasty is the most effective treatment of ST-segment elevation acute myocardial infarction (STEMI). However, its worldwide implementation is difficult to obtain. Therefore thrombolysis continues to be the treatment most commonly used.
To evaluate in-hospital and long term mortality of patients with STEMI treated with thrombolysis or angioplasty, in three hospitals participating in the Chilean National Registry of Acute MI (GEMI group).
Registry of 1,634 consecutive patients with STEMI admitted between 2002 and 2006. Risk was stratified using the Thrombolysis in Myocardial Infarction (TIMI) Risk Score. Hospital and log term mortalities were adjusted using logistic and Cox regression models.
Fifty nine percent of patients (967 patients aged 60+/-12 years, 77% males) were subjected to reperfusion therapies, 28% with primary angioplasty and 72% with thrombolysis. Hospital mortality rates among patients treated with thrombolysis and angioplasty were 10.9% and 5.6% (p =0.01), respectively The figures for long term mortality were 20.4% and 9.7%, respectively (p <0.01). Multivariate analysis confirmed the lower mortality among subjects treated with angioplasty, with an odds ratio (OR) in favor of angioplasty of 8.5 (95% confidence intervals (CI) 3-35) for in hospital mortality and of 4.7 (95% CI 2.6-8.3) for long term mortality. The higher benefits of angioplasty were observed in males, in the elderly and in patients with a TIMI score over >3.
Hospital and long term mortality of patients with STEMI was lower among those treated with primary angioplasty. This treatment is most beneficial among males, in the elderly and in patients with a TIMI score >3 .
直接血管成形术是ST段抬高型急性心肌梗死（STEMI）最有效的治疗方法。然而，在全球范围内难以广泛实施。因此，溶栓仍然是最常用的治疗方法。
在参与智利急性心肌梗死国家登记处（GEMI组）的三家医院中，评估接受溶栓或血管成形术治疗的STEMI患者的院内和长期死亡率。
登记2002年至2006年间连续收治的1634例STEMI患者。使用心肌梗死溶栓（TIMI）风险评分对风险进行分层。使用逻辑回归和Cox回归模型调整医院和长期死亡率。
59%的患者（967例年龄60±12岁，77%为男性）接受了再灌注治疗，28%接受直接血管成形术，72%接受溶栓治疗。接受溶栓和血管成形术治疗的患者院内死亡率分别为10.9%和5.6%（p = 0.01）。长期死亡率分别为20.4%和9.7%（p < 0.01）。多变量分析证实接受血管成形术治疗的患者死亡率较低，院内死亡率支持血管成形术的优势比（OR）为8.5（95%置信区间（CI）3 - 35），长期死亡率为4.7（95% CI 2.6 - 8.3）。在男性、老年人和TIMI评分>3的患者中观察到血管成形术的益处更大。
接受直接血管成形术治疗的STEMI患者的院内和长期死亡率较低。这种治疗方法在男性、老年人和TIMI评分>3的患者中最有益。
